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Parfenov VA, Bogolepova AN, Mkhitaryan EA. [Meta-analysis of randomized controlled trials of the effectiveness of Prospekta in the treatment of vascular cognitive impairment of varying severity]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:62-69. [PMID: 39072568 DOI: 10.17116/jnevro202412406162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To conduct a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of Prospekta in the treatment of SCI of varying severity. MATERIAL AND METHODS The meta-analysis included the results of RCTs of the efficacy of Prospekta in the treatment of VCI, the severity of which was assessed using the Montreal Cognitive Scale (MoCA). The pooled effect estimate included all publications of double-blind, placebo-controlled RCTs that provided sufficient MoCA efficacy data to support further statistical analysis. The main result of the meta-analysis was obtained for the final values of the efficacy indicator in the groups of patients receiving the drug Prospekta, in comparison with the placebo group. RESULTS A meta-analysis of the effectiveness of Prospekta in the treatment of SCI of varying severity was carried out based on data from 3 RCTs and 2 CTs involving 12.701 patients aged 18 years and older. When using the mixed models method, the effect size for the endpoint «change in total MoCA score from baseline to follow-up visit» was 3.4 points for Prospekta (2.7 points for placebo, p<0.0001); for the end point «∆ between changes in the total score on the MoCA scale while taking Prospekta and placebo» - 0.6736 points (p<0.0001). CONCLUSION A statistically significant improvement in cognitive function according to the MoCA scale was demonstrated in patients with VCI using the drug Prospekta.
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Affiliation(s)
- V A Parfenov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A N Bogolepova
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain and Neurotechnologies, Moscow, Russia
| | - E A Mkhitaryan
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Gerontology Research and Clinical Centre of the Pirogov Russian National Research Medical University, Moscow, Russia
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Aortic Stiffness: A Major Risk Factor for Multimorbidity in the Elderly. J Clin Med 2023; 12:jcm12062321. [PMID: 36983321 PMCID: PMC10058400 DOI: 10.3390/jcm12062321] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Multimorbidity, the coexistence of multiple health conditions in an individual, has emerged as one of the greatest challenges facing health services, and this crisis is partly driven by the aging population. Aging is associated with increased aortic stiffness (AoStiff), which in turn is linked with several morbidities frequently affecting and having disastrous consequences for the elderly. These include hypertension, ischemic heart disease, heart failure, atrial fibrillation, chronic kidney disease, anemia, ischemic stroke, and dementia. Two or more of these disorders (multimorbidity) often coexist in the same elderly patient and the specific multimorbidity pattern depends on several factors including sex, ethnicity, common morbidity routes, morbidity interactions, and genomics. Regular exercise, salt restriction, statins in patients at high atherosclerotic risk, and stringent blood pressure control are interventions that delay progression of AoStiff and most likely decrease multimorbidity in the elderly.
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Tan L, Xing J, Wang Z, Du X, Luo R, Wang J, Zhao J, Zhao W, Yin C. Study of gray matter atrophy pattern with subcortical ischemic vascular disease-vascular cognitive impairment no dementia based on structural magnetic resonance imaging. Front Aging Neurosci 2023; 15:1051177. [PMID: 36815175 PMCID: PMC9939744 DOI: 10.3389/fnagi.2023.1051177] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
Objective This study explored the structural imaging changes in patients with subcortical ischemic vascular disease (SIVD)-vascular cognitive impairment no dementia (VCIND) and the correlation between the changes in gray matter volume and the field of cognitive impairment to provide new targets for early diagnosis and treatment. Methods Our study included 15 patients with SIVD-normal cognitive impairment (SIVD-NCI), 63 with SIVD-VCIND, 26 with SIVD-vascular dementia (SIVD-VD), and 14 normal controls (NC). T1-weighted images of all participants were collected, and DPABI and SPM12 software were used to process the gray matter of the four groups based on voxels. Fisher's exact test, one-way ANOVA and Kruskal-Wallis H test were used to evaluate all clinical and demographic data and compare the characteristics of diencephalic gray matter atrophy in each group. Finally, the region of interest (ROI) of the SIVD-VCIND was extracted, and Pearson correlation analysis was performed between the ROI and the results of the neuropsychological scale. Results Compared to the NC, changes in gray matter atrophy were observed in the bilateral orbitofrontal gyrus, right middle temporal gyrus, superior temporal gyrus, and precuneus in the SIVD-VCIND. Gray matter atrophy was observed in the left cerebellar region 6, cerebellar crural region 1, bilateral thalamus, right precuneus, and calcarine in the SIVD-VD. Compared with the SIVD-VCIND, gray matter atrophy changes were observed in the bilateral thalamus in the SIVD-VD (p < 0.05, family-wise error corrected). In the SIVD-VCIND, the total gray matter volume, bilateral medial orbital superior frontal gyrus, right superior temporal gyrus, middle temporal gyrus, and precuneus were positively correlated with Boston Naming Test score, whereas the total gray matter volume, right superior temporal gyrus, and middle temporal gyrus were positively correlated with overall cognition. Conclusion Structural magnetic resonance imaging can detect extensive and subtle structural changes in the gray matter of patients with SIVD-VCIND and SIVD-VD, providing valuable evidences to explain the pathogenesis of subcortical vascular cognitive impairment and contributing to the early diagnosis of SIVD-VCIND and early warning of SIVD-VD.
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Affiliation(s)
- Lin Tan
- Department of Neurology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China,Department of Rehabilitation, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jian Xing
- Department of Imaging, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
| | - Zhenqi Wang
- Department of Neurology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
| | - Xiao Du
- Department of Neurology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
| | - Ruidi Luo
- Department of Neurology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
| | - Jianhang Wang
- Department of Neurology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
| | - Jinyi Zhao
- Department of Imaging, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
| | - Weina Zhao
- Department of Neurology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China,Heilongjiang Key Laboratory of Ischemic Stroke Prevention and Treatment, Mudanjiang, China,*Correspondence: Weina Zhao, ; Changhao Yin,
| | - Changhao Yin
- Department of Neurology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China,Heilongjiang Key Laboratory of Ischemic Stroke Prevention and Treatment, Mudanjiang, China,*Correspondence: Weina Zhao, ; Changhao Yin,
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Biesbroek JM, Biessels GJ. Diagnosing vascular cognitive impairment: Current challenges and future perspectives. Int J Stroke 2023; 18:36-43. [PMID: 35098817 PMCID: PMC9806474 DOI: 10.1177/17474930211073387] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Cerebrovascular disease is a major cause of cognitive decline and dementia. This is referred to as vascular cognitive impairment (VCI). Diagnosing VCI is important, among others to optimize treatment to prevent further vascular injury. This narrative review addresses challenges in current diagnostic approaches to VCI and potential future developments. First we summarize how diagnostic criteria for VCI evolved over time. We then highlight challenges in diagnosing VCI in clinical practice: assessment of severity of vascular brain injury on brain imaging is often imprecise and the relation between vascular lesion burden and cognitive functioning shows high intersubject variability. This can make it difficult to establish causality in individual patients. Moreover, because VCI is essentially an umbrella term, it lacks specificity on disease mechanisms, prognosis, and treatment. We see the need for a fundamentally different approach to diagnosing VCI, which should be more dimensional, including multimodal quantitative assessment of injury, with more accurate estimation of cognitive impact, and include biological definitions of disease that can support further development of targeted treatment. Recent developments in the field that can form the basis of such an approach are discussed.
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Affiliation(s)
- J Matthijs Biesbroek
- Department of Neurology, UMC Utrecht
Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands,Department of Neurology,
Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht
Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands,Geert Jan Biessels, Department of
Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, G03.232,
PO Box 85500, 3508 GA Utrecht, The Netherlands.
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Yang K, Zeng L, Ge A, Cao C, Zhang H, Bao T, Yi Y, Ge J. Systems Biology and Chemoinformatics-Based Strategies to Explore the Biological Mechanism of Fugui Wenyang Decoction in Treating Vascular Dementia Rats. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6693955. [PMID: 34659639 PMCID: PMC8517630 DOI: 10.1155/2021/6693955] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the biological mechanism of Fugui Wenyang Decoction (FGWYD) in treating vascular dementia (VD) rats based on systems pharmacology, proteomics, and a multidirectional pharmacology integration strategy. METHODS Chemoinformatics was utilized to construct and analyze the FGWYD-VD protein-protein interaction (PPI) network. Then, the total protein in the brain tissue of the infarcted side of the rat was extracted for protein identification, pattern identification, and protein quantitative analysis. The differentially expressed proteins are analyzed by bioinformatics. Finally, the important proteins in the oxidative stress-related biological process proteins and indicators were detected through experimental pharmacology to verify the findings of systems biology and chemoinformatics. RESULTS There were a total of 73 FGWYD components with 245 FGWYD and 145 VD genes. The results of GO enrichment analysis and pathway enrichment analysis showed that MBHD may regulate the inflammation module, oxidative stress, the synaptic plasticity regulation module, and the neuronal apoptosis section module. Compared with the sham operation group, there were 23 upregulated proteins and 17 downregulated proteins in the model group (P < 0.05). Compared with the model group, there were 16 upregulated proteins and 10 downregulated proteins in the FGWYD group (P < 0.05). Bioinformatics analysis shows that those proteins were closely related to processes such as inflammation, oxidative stress, neuronal apoptosis, neuronal growth and differentiation, signaling pathways, and transcriptional regulation. Multidirectional pharmacology further verified the neuroprotective mechanism of the Nrf2/HO-1 pathway in FGWYD treatment of VD. CONCLUSION The mechanism of FGWYD in the treatment of VD may be related to inflammation, oxidative stress, angiogenesis, and neuronal apoptosis.
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Affiliation(s)
- Kailin Yang
- Hunan University of Chinese Medicine, Changsha, Hunan Province, China
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan Province, China
| | - Liuting Zeng
- Hunan University of Chinese Medicine, Changsha, Hunan Province, China
| | - Anqi Ge
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan Province, China
| | - Chuandong Cao
- Hunan University of Chinese Medicine, Changsha, Hunan Province, China
| | - Haiyan Zhang
- Hunan University of Chinese Medicine, Changsha, Hunan Province, China
| | - Tingting Bao
- Beijing University of Chinese Medicine, Beijing, China
| | - Yaqiao Yi
- Hunan University of Chinese Medicine, Changsha, Hunan Province, China
| | - Jinwen Ge
- Hunan University of Chinese Medicine, Changsha, Hunan Province, China
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Pyne JD, Brickman AM. The Impact of the COVID-19 Pandemic on Dementia Risk: Potential Pathways to Cognitive Decline. NEURODEGENER DIS 2021; 21:1-23. [PMID: 34348321 PMCID: PMC8678181 DOI: 10.1159/000518581] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), the far-reaching pandemic, has infected approximately 185 million of the world's population to date. After infection, certain groups, including older adults, men, and people of color, are more likely to have adverse medical outcomes. COVID-19 can affect multiple organ systems, even among asymptomatic/mild severity individuals, with progressively worse damage for those with higher severity infections. SUMMARY The COVID-19 virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily attaches to cells through the angiotensin-converting enzyme 2 (ACE2) receptor, a universal receptor present in most major organ systems. As SARS-CoV-2 binds to the ACE2 receptor, its bioavailability becomes limited, thus disrupting homeostatic organ function and inducing an injury cascade. Organ damage can then arise from multiple sources including direct cellular infection, overactive detrimental systemic immune response, and ischemia/hypoxia through thromboembolisms or disruption of perfusion. In the brain, SARS-CoV-2 has neuroinvasive and neurotropic characteristics with acute and chronic neurovirulent potential. In the cardiovascular system, COVID-19 can induce myocardial and systemic vascular damage along with thrombosis. Other organ systems such as the lungs, kidney, and liver are all at risk for infection damage. Key Messages: Our hypothesis is that each injury consequence has the independent potential to contribute to long-term cognitive deficits with the possibility of progressing to or worsening pre-existing dementia. Already, reports from recovered COVID-19 patients indicate that cognitive alterations and long-term symptoms are prevalent. This critical review highlights the injury pathways possible through SARS-CoV-2 infection that have the potential to increase and contribute to cognitive impairment and dementia.
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Affiliation(s)
- Jeffrey D. Pyne
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Adam M. Brickman
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Verdelho A, Wardlaw J, Pavlovic A, Pantoni L, Godefroy O, Duering M, Charidimou A, Chabriat H, Biessels GJ. Cognitive impairment in patients with cerebrovascular disease: A white paper from the links between stroke ESO Dementia Committee. Eur Stroke J 2021; 6:5-17. [PMID: 33817330 PMCID: PMC7995319 DOI: 10.1177/23969873211000258] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Many daily-life clinical decisions in patients with cerebrovascular disease and cognitive impairment are complex. Evidence-based information sustaining these decisions is frequently lacking. The aim of this paper is to propose a practical clinical approach to cognitive impairments in patients with known cerebrovascular disease. METHODS The document was produced by the Dementia Committee of the European Stroke Organisation (ESO), based on evidence from the literature where available and on the clinical experience of the Committee members. This paper was endorsed by the ESO. FINDINGS Many patients with stroke or other cerebrovascular disease have cognitive impairment, but this is often not recognized. With improvement in acute stroke care, and with the ageing of populations, it is expected that more stroke survivors and more patients with cerebrovascular disease will need adequate management of cognitive impairment of vascular etiology. This document was conceived for the use of strokologists and for those clinicians involved in cerebrovascular disease, with specific and practical hints concerning diagnostic tools, cognitive impairment management and decision on some therapeutic options.Discussion and conclusions: It is essential to consider a possible cognitive deterioration in every patient who experiences a stroke. Neuropsychological evaluation should be adapted to the clinical status. Brain imaging is the most informative biomarker concerning prognosis. Treatment should always include adequate secondary prevention.
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Affiliation(s)
- Ana Verdelho
- Department of Neurosciences and Mental Health, CHLN-Hospital de Santa Maria, Instituto de Medicina Molecular – IMM e Instituto de Saúde Ambiental –ISAMB, Faculdade de Medicina, University of Lisbon, Lisbon, Portugal
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Aleksandra Pavlovic
- Faculty for Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Leonardo Pantoni
- Stroke and Dementia Lab, "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, Laboratory of Functional Neurosciences1,6 (UR UPJV 4559), Jules Verne Picardy University, Amiens, France
| | - Marco Duering
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Andreas Charidimou
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Hugues Chabriat
- Department of Neurology, FHU NeuroVasc, Hôpital Lariboisiere, University of Paris, Paris, France
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
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SFC-MS/MS method for simultaneous determination of nimodipine and 3-n-butylphthalide in beagle plasma: application to pharmacokinetic interaction study. Bioanalysis 2020; 12:1509-1519. [PMID: 33078962 DOI: 10.4155/bio-2020-0229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Aim: Nimodipine and 3-n-butylphthalide are co-administered to treat vascular dementia, but the pharmacokinetic interaction between the two drugs is still unknown. Therefore, a robust, high-throughput and economical supercritical fluid chromatography-ESI-MS/MS method has been initially developed to simultaneously determine nimodipine and 3-n-butylphthalide in beagle plasma, in order to study the safety of co-administration. Materials & methods: After a simple protein precipitation procedure, isocratic elution with mobile phase of CO2 and methanol (containing 0.3% formic acid and 2 mM ammonium acetate) was applied to minimize run time and facilitate sensitive and high-throughput bioanalysis. The method was fully validated according to US FDA Guidance. The validated method was then successfully applied in a pharmacokinetic interaction study. Results: The results indicated there is no significant pharmacokinetic interaction between the two drugs.
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Li Y, Liu Y, Wang P, Wang J, Xu S, Qiu M. Dependency criterion based brain pathological age estimation of Alzheimer's disease patients with MR scans. Biomed Eng Online 2017; 16:50. [PMID: 28438167 PMCID: PMC5404315 DOI: 10.1186/s12938-017-0342-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/19/2017] [Indexed: 12/20/2022] Open
Abstract
Objectives Traditional brain age estimation methods are based on the idea that uses the real age as the training label. However, these methods ignore that there is a deviation between the real age and the brain age due to the accelerated brain aging. Methods This paper considers this deviation and obtains it by maximizing the correlation between the estimated brain age and the class label rather than by minimizing the difference between the estimated brain age and the real age. Firstly, set the search range of the deviation as the deviation candidates according to the prior knowledge. Secondly, use the support vector regression as the age estimation model to minimize the difference between the estimated age and the real age plus deviation rather than the real age itself. Thirdly, design the fitness function based on the correlation criterion. Fourthly, conduct age estimation on the validation dataset using the trained age estimation model, put the estimated age into the fitness function, and obtain the fitness value of the deviation candidate. Fifthly, repeat the iteration until all the deviation candidates are involved and get the optimal deviation with maximum fitness values. The real age plus the optimal deviation is taken as the brain pathological age. Results The experimental results showed that the separability of the samples was apparently improved. For normal control- Alzheimer’s disease (NC-AD), normal control- mild cognition impairment (NC-MCI), and mild cognition impairment—Alzheimer’s disease (MCI-AD), the average improvements were 0.164 (31.66%), 0.1284 (34.29%), and 0.0206 (7.1%), respectively. For NC-MCI-AD, the average improvement was 0.2002 (50.39%). The estimated brain pathological age could be not only more helpful for the classification of AD but also more precisely reflect the accelerated brain aging. Conclusion In conclusion, this paper proposes a new kind of brain age—brain pathological age and offers an estimation method for it that can distinguish different states of AD, thereby better reflecting accelerated brain aging. Besides, the brain pathological age is most helpful for feature reduction, thereby simplifying the relevant classification algorithm.
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Affiliation(s)
- Yongming Li
- College of Communication Engineering, Chongqing University, Shapingba District, Chongqing, 400044, China. .,Department of Medical Image, College of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China. .,Collaborative Innovation Center for Brain Science, Chongqing University, Chongqing, 400044, China.
| | - Yuchuan Liu
- College of Communication Engineering, Chongqing University, Shapingba District, Chongqing, 400044, China
| | - Pin Wang
- College of Communication Engineering, Chongqing University, Shapingba District, Chongqing, 400044, China
| | - Jie Wang
- College of Communication Engineering, Chongqing University, Shapingba District, Chongqing, 400044, China
| | - Sha Xu
- College of Communication Engineering, Chongqing University, Shapingba District, Chongqing, 400044, China
| | - Mingguo Qiu
- Department of Medical Image, College of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China
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Boomsma JMF, Exalto LG, Barkhof F, van den Berg E, de Bresser J, Heinen R, Koek HL, Prins ND, Scheltens P, Weinstein HC, van der Flier WM, Biessels GJ. Vascular Cognitive Impairment in a Memory Clinic Population: Rationale and Design of the "Utrecht-Amsterdam Clinical Features and Prognosis in Vascular Cognitive Impairment" (TRACE-VCI) Study. JMIR Res Protoc 2017; 6:e60. [PMID: 28428166 PMCID: PMC5415656 DOI: 10.2196/resprot.6864] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/29/2017] [Accepted: 02/14/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Vascular Cognitive Impairment (VCI) refers to cognitive dysfunction due to vascular brain injury, as a single cause or in combination with other, often neurodegenerative, etiologies. VCI is a broad construct that captures a heterogeneous patient population both in terms of cognitive and noncognitive symptoms and in terms of etiology and prognosis. This provides a challenge when applying this construct in clinical practice. OBJECTIVE This paper presents the rationale and design of the TRACE-VCI study, which investigates the clinical features and prognosis of VCI in a memory clinic setting. METHODS The TRACE-VCI project is an observational, prospective cohort study of 861 consecutive memory clinic patients with possible VCI. Between 2009 and 2013, patients were recruited through the Amsterdam Dementia Cohort of the VU University Medical Centre (VUMC) (N=665) and the outpatient memory clinic and VCI cohort of the University Medical Centre Utrecht (UMCU) (N=196). We included all patients attending the clinics with magnetic resonance imaging (MRI) evidence of vascular brain injury. Patients with a primary etiology other than vascular brain injury or neurodegeneration were excluded. Patients underwent an extensive 1-day memory clinic evaluation including an interview, physical and neurological examination, assessment of biomarkers (including those for Alzheimer-type pathologies), extensive neuropsychological testing, and an MRI scan of the brain. For prognostic analyses, the composite primary outcome measure was defined as accelerated cognitive decline (change of clinical dementia rating ≥1 or institutionalization) or (recurrent) major vascular events or death over the course of 2 years. RESULTS The mean age at baseline was 67.7 (SD 8.5) years and 46.3% of patients (399/861) were female. At baseline, the median Clinical Dementia Rating was 0.5 (interquartile range [IQR] 0.5-1.0) and the median Mini-Mental State Examination score was 25 (IQR 22-28). The clinical diagnosis at baseline was dementia in 52.4% of patients (451/861), mild cognitive impairment in 24.6% (212/861), and no objective cognitive impairment in the remaining 23.0% (198/861). CONCLUSIONS The TRACE-VCI study represents a large cohort of well-characterized patients with VCI in a memory clinic setting. Data processing and collection for follow-up are currently being completed. The TRACE-VCI study will provide insight into the clinical features of memory clinic patients that meet VCI criteria and establish key prognostic factors for further cognitive decline and (recurrent) major vascular events.
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Affiliation(s)
- Jooske Marije Funke Boomsma
- Department of Neurology, Neurosurgery and Neuropsychology, Brain Centre Rudolf Magnus Institute, University Medical Centre Utrecht, Utrecht, Netherlands
- Onze Lieve Vrouwe Gasthuis (OLVG) West, Department of Neurology, Amsterdam, Netherlands
| | - Lieza Geertje Exalto
- Department of Neurology, Neurosurgery and Neuropsychology, Brain Centre Rudolf Magnus Institute, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, VU University Medical Centre, Amsterdam, Netherlands
| | - Esther van den Berg
- Department of Neurology, Neurosurgery and Neuropsychology, Brain Centre Rudolf Magnus Institute, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Neurology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Jeroen de Bresser
- Department of Radiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Rutger Heinen
- Department of Neurology, Neurosurgery and Neuropsychology, Brain Centre Rudolf Magnus Institute, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Huiberdina Lena Koek
- Department of Geriatrics, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Niels Daniël Prins
- Alzheimer Centre and Department of Neurology, VU University Medical Centre, Amsterdam, Netherlands
| | - Philip Scheltens
- Alzheimer Centre and Department of Neurology, VU University Medical Centre, Amsterdam, Netherlands
| | | | - Wiesje Maria van der Flier
- Alzheimer Centre and Department of Neurology, VU University Medical Centre, Amsterdam, Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Neurosurgery and Neuropsychology, Brain Centre Rudolf Magnus Institute, University Medical Centre Utrecht, Utrecht, Netherlands
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Morley JE. The Future of Long-Term Care. J Am Med Dir Assoc 2017; 18:1-7. [DOI: 10.1016/j.jamda.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 02/07/2023]
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Wardlaw JM, Horsburgh K. Small vessels, dementia and chronic diseases-molecular mechanisms and pathophysiology. Clin Sci (Lond) 2016; 130:1875-9. [PMID: 27660310 DOI: 10.1042/cs20160376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/04/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Joanna M Wardlaw
- Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh EH16 4SB, U.K.
| | - Karen Horsburgh
- Centre for Neuroregeneration, Chancellor's Building, University of Edinburgh, Edinburgh EH16 4SB, U.K
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Li Y, Li F, Wang P, Zhu X, Liu S, Qiu M, Zhang J, Zeng X. Estimating the brain pathological age of Alzheimer's disease patients from MR image data based on the separability distance criterion. Phys Med Biol 2016; 61:7162-7186. [PMID: 27649031 DOI: 10.1088/0031-9155/61/19/7162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Traditional age estimation methods are based on the same idea that uses the real age as the training label. However, these methods ignore that there is a deviation between the real age and the brain age due to accelerated brain aging. This paper considers this deviation and searches for it by maximizing the separability distance value rather than by minimizing the difference between the estimated brain age and the real age. Firstly, set the search range of the deviation as the deviation candidates according to prior knowledge. Secondly, use the support vector regression (SVR) as the age estimation model to minimize the difference between the estimated age and the real age plus deviation rather than the real age itself. Thirdly, design the fitness function based on the separability distance criterion. Fourthly, conduct age estimation on the validation dataset using the trained age estimation model, put the estimated age into the fitness function, and obtain the fitness value of the deviation candidate. Fifthly, repeat the iteration until all the deviation candidates are involved and get the optimal deviation with maximum fitness values. The real age plus the optimal deviation is taken as the brain pathological age. The experimental results showed that the separability was apparently improved. For normal control-Alzheimer's disease (NC-AD), normal control-mild cognition impairment (NC-MCI), and MCI-AD, the average improvements were 0.178 (35.11%), 0.033 (14.47%), and 0.017 (39.53%), respectively. For NC-MCI-AD, the average improvement was 0.2287 (64.22%). The estimated brain pathological age could be not only more helpful to the classification of AD but also more precisely reflect accelerated brain aging. In conclusion, this paper offers a new method for brain age estimation that can distinguish different states of AD and can better reflect the extent of accelerated aging.
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Affiliation(s)
- Yongming Li
- College of Communication Engineering, Chongqing University, Chongqing 400044, People's Republic of China. Department of Medical Image, College of Biomedical Engineering, Third Military Medical University, Chongqing 400038, People's Republic of China
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Abstract
Antidementive drugs have made Alzheimer's disease a symptomatically treatable condition but have essentially bypassed vascular dementia. The complexity of its pathology, the variable pathognomonic manifestations, the absence of validated biomarkers and the continuum with Alzheimer's disease that makes vascular dementia a comparatively small market are the major contributing factors. This report discusses how drug repurposing can be harnessed to identify new therapeutic opportunities, where such efforts are already yielding promising results, and which ones must be considered failures. Most investigations address obvious aspects cerebral small vessel disease, but some early-stage developments attempt changes in gene expression or modulation of complex biological pathways. A stronger focus on the nature and dynamics of white matter lesions should yield additional molecular targets.
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Affiliation(s)
- Hermann AM Mucke
- HM Pharma Consultancy, Enenkelstrasse 28/32, A-1160 Vienna, Austria
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